Paediatric Otorhinolaryngology Flashcards
How do ontological disease present?
Hearing loss
Discharging ear
Ear ache
Tinnitus
Vertigo
What are things to consider for a child with hearing loss?
Congenital vs acquired
Unilateral vs bilateral
Conductive vs sensorineural
What is could be in a history in a child with hearing loss?
Ear symptoms
-pain
-discharge
-loss of function- hearing loss, dizziness, tinnitus
Speech development, school performance lacking
Behavioural problems
Maternal perinatal infection
Delivery issues
Neonatal infections, drugs, jaundice
Growth, immunisations, passive smoking, breast vs bottle feeding
Assessments should be done of children and of what age?
6-18 moths= distraction test
12 months- 3 years= visual reinforced audiometry
3-5 years= play audiometry
4 years += pure tone audiometry
What are objective assessment of auditory system?
Otoacoustic emissions
Auditory brain stem responses
Typmanometry
How common is otitis media in children?
80% before 10YR
At what ages is otitis media most common?
2yr and 5yr
What are the riskfactors for otitis media?
Day care
Smoking
Cleft palate
Down syndrome
How is otitis media with effusion treated?
Most clear by themselves
Treat with hearing aids or grommets and adenoidectomy
What are symptoms of otitis media with effusion?
Hearing loss
Speech delay
Behavioural problems
Academic decline
(Imbalance)
What are signs of otitis media w/ effusion?
Dull TM
Fluid level
Bubbles
What is the aetiology of otitis media w/ effusion?
Eustachian tube dysfunction
- anatomy of skull base
-muscular immaturity
Adenoidal hypertrophy
Resolving AOM
Treatment of otitis media with effusion?
Auto inflation
Grommet
What do you need to do in a child with painful/ discharging ear?
History
Examination
Investigation
What is the treatment for otitis externa?
Aural micro suction
Topical antibiotics
Water precaution
What is the typical history in acute otitis media?
Short history
Pain
Fever
Discharge
What is the microbiology of acute otitis media?
Haemophilus influenza
Strep pneumonia
Moraxella catarrhalis
How do you treat acute otitis media?
Treat with antibiotics
Grommets + adenoidectomy if recurrent
What is a complication of acute otitis media?
Brain abscess
When should you suspect chronic otitis media/ cholesteatoma?
In children w/
Chronic discharging ear
Hearing loss despite grommets
What is the treatment of chronic otitis media, cholesteatoma
Mastoidectomy
When does the ethmoidal and maxillary sinuses fully develop?
0-4 months
When does the sphenoid sinus fully develop?
3-7yr
When does the frontal sinus fully develop?
8yr - adolescent
What is the typical history of a child with a blocked/runny nose?
Nasal symptoms
-pain
-discharge
-loss of function - blocked nose, sense of smell
History of foreign body
Feeding
Snoring, quality of sleep
What do you need to distinguish with rhinitis?
Allergic vs non-allergic
What should you investigate in rhinitis?
Allergen test (IgE)
What is the treatment in rhinitis?
Nasal douching
Antihistamines
Nasal steroids
What should you check for in large adenoids?
Check for sleep apnoea
What does a nasal foreign body tend to be?
Unilateral
What does a nasal foreign body need?
Needs EUA
What does sinusitis and polyps have overlapping symptoms with?
Rhinitis/ large adenoids
What is sinusitis and nasal polyps associated with?
Cystic fibrosis
What can be a complication of sinusitis and polyps?
Orbital cellulitis
What is orbital cellulitis?
Sinusitis of ethmoid cells
Swollen eyes
What does bilateral chonanal atresia do?
Manifest as unable to breathe
Who is epitaxis more common in?
Males over females
What should be considered in epitaxis?
Coagulpathy
Haematological abnormality
What is littles area?
Lots of little arteries come together
What is the management of epitaxis?
Appropriate 1st aid
Antibiotic treatment (naseptin, bactroban)
Cautery (silver nitrate under LA, diathermy under GA)
Nasal packing
What is a typical history of a child with a sore throat?
Throat symptoms
-pain(odonophagia, ear ache)
-discharge (cough)
- loss of function (dysphagia, breathing problems, hoarse voice)
Snoring, drooling
Where should you exam with a sore throat?
Throat
Neck
Ears and nose
What can tonsillitis be caused by?
Bacterial (B haem or strep B)
Viral (EBV)
What is there a risk of in tonsilitis?
Glomerulonephritis
What is the treatment of tonsilitis?
Supportive
Antibiotics
What can be a complication of tonsillitis?
Peritonsillar abscess
What could be the anatomy and physiology of a child with airway issues?
Large tongue
Large tonsils
Large epiglottis
Short neck
Subglottis narrowest
What is the typical history of a child with airway issues?
Usually an emergency
Hx of foreign body
Recent illness
Feeding problems
Stridor - inspiratory
What could be pathology behind neck lumps?
Thyroglossal duct cyst
Brachial cyst
Cystic hygroma
Cervical lymphadenopathy
